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From the 1/14/2022 release of VAERS data:

This is VAERS ID 903413

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Case Details

VAERS ID: 903413 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2020-12-16
Onset:2020-12-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu Vaccine; anaphylaxis. All other details unknown
Other Medications: fluoxetine, metformin, albuterol MDI, Vitamin D3, propranolol
Current Illness:
Preexisting Conditions: Diabetes Type II
Allergies: corticosteroids, levofloxacin, shellfish, penicillin, Flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 12/16/2020, approximately two hours after administration of Pfizer BioNTech Covid-19 vaccine, patient developed SOB and chest pain. Patient reported to ED where she was given fluids, diphenhydramine, ipratropium/albuterol nebulizer treatment, magnesium, famotidine, and epinephrine. Of note, patient has anaphylactic reaction to corticosteroids. On 12/17/2020, around 3:00 pm the patient reports to the ED at a different facility (one closer to her home) with difficulty breathing and sensation of her airway closing. Patient again was given epinephrine, fluids, ipratropium/albuterol nebulizer, diphenhydramine, famotidine, and was also given a dose of lorazepam. The patient now has stated that she had an anaphylactic reaction to a prior flu vaccine, however this was not listed as an allergy prior to administration of the Pfizer BioNTech Covid-19 Vaccine.


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